Basophil Activation Test Using Recombinant Allergens: Highly Specific Diagnostic Method Complementing Routine Tests in Wasp Venom Allergy

Background Skin testing can expose allergic subjects to potential systemic reactions, sensitization against unrelated proteins, and increased risk of future stingreactions. Therefore the continuous improvement of in vitro diagnostic methods is desirable. Recombinant allergenshave been shown to improve the sensitivity of specific IgE (sIgE) detection in vitro whilst no data is available regarding their application and reliability in basophil activationtest (BAT). Here we aimed to compare the specificity and sensitivity of recombinant allergensVes v 1, Ves v 2, Ves v 3 and Ves v 5 in both specific IgE (sIgE) detection in vitro and basophil activationtest. Methods sIgE detection by ELISA or ImmunoCAP and BAT towards the panel of recombinant allergensVes v 1, Ves v 2, Ves v 3 and Ves v 5 were performed in 43 wasp venom allergic patients with a history of anaphylactic reactionand sIgE seropositivity, as well as 17 controls defined as subjects with a history of repetitive wasp stingsbut absence of any allergic symptom. Results The BAT performed with the recombinant allergensVes v 1, Ves v 2, Ves v 3 and Ves v 5 markedly improved the specificity of diagnosis in wasp venom allergic subjects when compared to the respective sIgE detection in serum. Conclusions BAT performed with the recombinant allergensVes v 5, Ves v 3 and Ves v 1 provides an emerging highly specific in vitro method for the detection of wasp venom allergy, compared to the sIgE detection. Recombinant allergensapplied to BAT represent a step forward in developing reliable in vitro tests for specific diagnosis of allergy.